Teaching biopsychosocial competence and the principles of primary health care (PHC) at the patient’s bedside

Abstract

The importance of behavioural and social determinants in health was recognised long ago, yet we still grapple with the challenges of developing appropriate teaching pedagogies to bring these principles into routine clinical practice. A teaching pedagogy blending the biopsychosocial approach and the principles of primary health care (PHC), as expressed in the Alma-Ata Declaration of 1978, is lacking in the literature. This report hopes to address this need. In 1994 the University of Cape Town (UCT), South Africa, adopted a PHC-based approach to health sciences education to equip its graduates with the necessary knowledge, skills and attributes required to meet the challenges of providing health care in a country with vast socio-political inequalities. This paper describes an educational pedagogy which weaves these principles into clinical practice in an undergraduate medical clerkship. The methodology uses real patient encounters linked to an interactive seminar and a portfolio of case studies. Students described the teaching pedagogy as interesting and informative. They recognised the importance of holistic, patient-centered care based on a biopsychosocial approach and the importance of the PHC principles. Barriers to implementing this approach were also highlighted. The pedagogy, in use for four years, is being adopted by another department, indicating the sustainability and success of the course.